Gabriela Raggi
Quincy
Summary
Dynamic healthcare leader with extensive experience, excelling in project management and clinical audits. Proven track record in enhancing team performance and implementing robotic process automation. Adept at fostering professional growth and promoting quality initiatives, leveraging strong communication skills to drive impactful results in nursing practices.
Overview
13
13
years of professional experience
Work History
Manager, Clinical Quality & Analysis
Point32Health
10.2022 - Current
- Manage group of registered nurses and program managers
- Led colleague resource group focused on professional growth and health initiatives for female employees
- Oversee multiple medical record review audits
- Manage robotic process automation projects in collaboration with software developer
Practice Committee Vice-Chair
American Holistic Nurses Association
01.2021 - Current
- Create content for networking calls within the organization through the use of evidence-based nursing articles
- Co-lead multiple projects within the practice committee
- Promote holistic nursing practices within the nursing profession
Clinical Manager
Senior Whole Health/Molina Healthcare
04.2020 - 12.2022
- Oversaw team of registered nurse care managers
- Audited using the Model of Care for a Special Needs Plan, performed by the Centers for Medicare and Medicaid Services (CMS)
- Performed National Committee for Quality Assurance (NCQA) audits
Clinical Training Consultant
United Healthcare
04.2019 - 04.2020
- Provided training to 170 nurse case managers in the health plan
- Created job aids and reference guides for the health plan for MA
- Facilitated online professional development programs for nursing staff through advanced tools
Clinical Appeals Registered Nurse
Optum
09.2017 - 04.2019
- Developed and delivered bilingual testimonies for MassHealth home health services hearings at the Board of Hearings
- Completed authorization reviews to facilitate home healthcare services for MassHealth
- Utilized Long-Term Services and Supports as well as Medical Management Information Systems for optimized efficiency
- Complied with home health and MassHealth standards
Registered Nurse Care Manager & Clinical Liaison
United Healthcare
06.2014 - 08.2017
- Conducted face-to-face assessments for Senior Care Options members in English, Spanish, and Portuguese
- Facilitated audits focusing on the Model of Care to meet NCQA regulations for a cohort of 12 nurses
- Created comprehensive job aids
Medical Reviewer/Registered Nurse
National Heritage Insurance Company
07.2012 - 06.2014
- Conducted medical reviews for prepaid items in alignment with Medicare guidelines.
- Led and coordinated the adoption of innovative CMS demonstration review initiatives.
Education
Master of Science - Nursing Leadership and Administration
Capella University
06.2019
Bachelor of Science - Nursing
University of Massachusetts Boston
05.2013
Associate of Science - Nursing
Quincy College
05.2011
Skills
- Project management
- Data analysis
- Robotic process automation
- Clinical audits
- Team leadership
- Performance improvement
- Employee training
- Communication skills
- Recruiting and interviewing
- Business planning
References
Available upon request
Timeline
Manager, Clinical Quality & Analysis
Point32Health
10.2022 - Current
Practice Committee Vice-Chair
American Holistic Nurses Association
01.2021 - Current
Clinical Manager
Senior Whole Health/Molina Healthcare
04.2020 - 12.2022
Clinical Training Consultant
United Healthcare
04.2019 - 04.2020
Clinical Appeals Registered Nurse
Optum
09.2017 - 04.2019
Registered Nurse Care Manager & Clinical Liaison
United Healthcare
06.2014 - 08.2017
Medical Reviewer/Registered Nurse
National Heritage Insurance Company
07.2012 - 06.2014
Master of Science - Nursing Leadership and Administration
Capella University
Bachelor of Science - Nursing
University of Massachusetts Boston
Associate of Science - Nursing
Quincy College
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